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Detection of cytomegalovirus drug resistance mutations in solid
                organ transplant recipients with suspected resistance

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BACKGROUND: Current guidelines recommend that treatment of
                resistant cytomegalovirus (CMV) in solid organ transplant (SOT)
                recipients must be based on genotypic analysis. However, this
                recommendation is not systematically followed. OBJECTIVES: To
                assess the presence of mutations associated with CMV resistance
                in SOT recipients with suspected resistance, their associated
                risk factors and the clinical impact of resistance. STUDY
                DESIGN: Using Sanger sequencing we prospectively assessed the
                presence of resistance mutations in a nation-wide prospective
                study between September 2013-August 2015. RESULTS: Of 39
                patients studied, 9 (23%) showed resistance mutations. All had
                one mutation in the UL 97 gene and two also had one mutation in
                the UL54 gene. Resistance mutations were more frequent in lung
                transplant recipients (44% p=0.0068) and in patients receiving
                prophylaxis >/=6 months (57% vs. 17%, p=0.0180). The mean
                time between transplantation and suspicion of resistance was
                longer in patients with mutations (239 vs. 100days,
                respectively, p=0.0046) as was the median treatment duration
                before suspicion (45 vs. 16days, p=0.0081). There were no
                significant differences according to the treatment strategies or
                the mean CMV load at the time of suspicion. Of note,
                resistance-associated mutations appeared in one patient during
                CMV prophylaxis and also in a seropositive organ recipient.
                Incomplete suppression of CMV was more frequent in patients with
                confirmed resistance. CONCLUSIONS: Our study confirms the need
                to assess CMV resistance mutations in any patient with criteria
                of suspected clinical resistance. Early confirmation of the
                presence of resistance mutations is essential to optimize the
                management of these patients.

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Versió postprint del document publicat a:
                http://dx.doi.org/10.1016/j.jcv.2017.03.014

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Journal of Clinical Virology, 2017, vol. 90, p. 57-63

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Articles publicats en revistes (ISGlobal)

# metadata.dc.title[].value
Detection of cytomegalovirus drug resistance mutations in solid
                organ transplant recipients with suspected resistance